PSA rising after 70.2Gys Radiation, where to next?

malweb03 · New User Joined: 13 Apr 2008 Posts: 1 Location: Gold Coast

I was diagnosed with prostate cancer back in 1997 - PSA 6 and Gleason 6 (3+3) and had proton and electron treatment in USA later that year. My PSA levels declined up until 18 months ago and have doubled since then from 0.5 to 1 U/gl

I will be 70 next month, and also have Type 2 diabetes and high blood pressure.

I am wondering what to do next, and whether brachytherapy is an option. Confused

I am having a bone scan tomorrow to see if any of the cancer has metastazied.

I would appreciate any comments
Thanks

brainman

Hi malweb03. I am very sorry that your cancer has recurred. I do not know what the options are for you at this point. I just wanted to say how much I admire your courage and longevity. You are having to deal with so many different health issues!

I am sure others will have more information as to your options. Keep us informed.

You are in my thoughts and prayers.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

chrisz · Regular Joined: 09 Apr 2007 Posts: 29

Even if the cancer has spread, it can be slowed down considerably.
You haven't said anything about hormone treatment, so I guess you haven't tried that yet.

Also their are new drugs and treatments coming out all the time.

See this article about my uncle. He has survived PC now for 16 years.
He did not go to the doctor until it was inoperable. He tried this new
drug : http://hamptonroads.com/node/273201

Chris

Replicant · Moderator Joined: 01 Nov 2006 Posts: 163

Apparently this has been done (brachytherapy as salvage after radiation fails as primary).

"Depending on initial prognostic factors, an estimated 10%-60% of men who undergo definitive radiation therapy for prostate cancer may experience a biochemical recurrence. Even though hormonal therapy is standard for metastatic recurrences, no consensus exists on optimal salvage therapy for those recurrences thought confined to the prostate. Salvage treatment options for these local recurrences have historically been limited to salvage prostatectomy, hormonal therapy, or cryotherapy. Salvage prostate brachytherapy, however, uses a widely available technique and may provide another option for attaining disease control in patients with localized failures, although only about 110 cases have been reported in the literature. In this report, the authors have described their own series of salvage brachytherapy cases as well as presented a review of other such series reported in the literature. In addition, the authors included a comprehensive review of published experiences with surgery and cryotherapy as salvage options. It appears that salvage brachytherapy, when combined with careful patient selection, is at least as effective as other salvage options with comparable or potentially fewer treatment-related side effects."
From:
Management of prostate cancer recurrences after radiation therapy-brachytherapy as a salvage option.
Allen GW, Howard AR, Jarrard DF, Ritter MA.
Cancer. 2007 Oct 1;110(7):1405-16.
http://www.ncbi.nlm.nih.gov/pubmed/17685384

So--it looks possible but very rarely done. You'd probably have a hard time finding a good doctor to to do it. More common would be a salvage prostatectomy--but be warned--salvage prostatectomies are technically VERY challenging for the surgeon and patients often come out with high rates of morbidity in the form of very bad incontinence, impotence, and rectal injury. Anecdotally, I know of two patients from another discussion board. One did great with a salvage prostatectomy and the other is in misery with extreme incontinence, fistulas, terrible problems.

The other option, salvage cryo, is unknown territory to me, but I know that it is done.

There is no guarantee that your cancer is localized. The bone scan will only show bone metastases and usually only if your PSA is 20 or higher. Microscopic metastases will not show up, nor will metastases in soft tissues. I think about scans this way--they can rule IN metastatic disease but they can't rule it OUT.

If I were in your shoes, at 70, I would be highly attracted to hormone therapy (androgen deprivation therapy, or ADT). Even though MOST men see their PSAs bottom out for a year or a few years, some go much longer--and after that, there are new chemo regimens with more coming all the time. The question with ADT would be "now or later". There are some urologists and oncologists who think that there is no reason to start ADT immediately with PSA-only recurrences. Patrick Walsh is in that camp. Others think the earlier you start, the better.

I'm sure you'll discuss all this with your doctor. Best wishes.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

chrisz · Regular Joined: 09 Apr 2007 Posts: 29

Hi Malweb03.

I'm with Replicant. Prostate cancer in itself if very slow growing. I just read that most doctors quite checking PSA after 70 years old. Because "the patient will most likely die of something else before Prostate cancer". This is for a person who hasn't had PC.

Others on here might know how aggressive 3+3, I think it's about average.

The story on my uncle is that he had inoperable cancer the first time he went to a Udoc. He was on hormone therapy for quite awhile, like 8 years, and the cancer was very slow to grow.

I think you will die of something else first. Now doesn't that make you feel better. LOL. Let's face it, were all gonna die. We should feel lucky we made it till this age. Many people die very early in life unfortunately.

Okay ???? So how did your bone scan come out ???????

And you,,,, Replicant, how did your 3 month PSA turn out ?

Chris

	Cancer Forums Forum Index -> Prostate Cancer Forum	All times are GMT - 5 Hours
Page 1 of 1

A website for discussions about any type of cancer, including lung cancer, breast cancer, mesothelioma, prostate cancer, laryngeal cancer, leukemia, lymphoma, multiple myeloma and others